Blow-out Fracture M Rinaldi Dahlan - PowerPoint Presentation

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Blow-out Fracture

M Rinaldi Dahlan

Cicendo

Eye Hospital Bandung

Department of Ophthalmology

Faculty of Medicine

Universitas

Padjadjaran

Introduction

Orbital fracture

is the most common type of fracture of the orbital walls

Introduction

Medial wall

Orbital floor

 most vulnerable

The term Blow-out fracture refers specifically to the fracture of an orbital wall in the presence of an intact orbital rim

The thin part of the maxillary bone ( 0,5 mm thick in this area)

Introduction

Mc

Kenzie

(1844)  describe floor fracture

Smith and Converse (1956)blow out fracture

Mechanism:

Blunt

traumapushes

the orbital tissue

posteriorlyincrease

in intraorbital pressurethe orbital bones to break at their weakest point posterior medial aspect of the orbital floor

Clinical Presentation

External sign: Lid edema, subcutaneous or orbital emphysema,

Ecchymosis

, Subconjunctival hemorrhage,

enophthalmos

, globe

ptosison some occasions, there may be little or no signs of external injury Ocular injury

 anisocoria can occur with inferior floor fracture

Diplopia

Infraorbital

nerve hypesthesiaOcular Motility, small fracture incarcerate

Evaluation

Visual acuity, pupil, intraocular pressure,

biomicroscopy

and

fundus

.

Globe position 

hertel exophthalmometry

Ocular motility  injury to the extra ocular muscle or cranial nerve palsy

Diplopia

visual fieldsPhotographs  as documentation  for patients to appreciate an acceptable operative result

Force duction

test  paretic and restrictive

motility patterns

X ray , CT scans

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Management

Smith and Converse: early surgical correction

Putterman

et al: 4-6 months surgical and non surgical

Dutton: early repair symptomatic persistent

diplopia

with

positif force ductions

, CT evidence of orbital tissue or muscle entrapment, no clinical improvement over 1-2 weeks,

enophthalmos

of 3mm or more, significant globe ptosis, floor defect > 50%Conservative/ observation: minimal diplopia

with good motility, no CT evidence of tissue entrapment, absence enophthalmos

or globe

ptosis

.

The goal of blowout # repair :

- Free entrapped orbital tissue

- Return orbital volume to normal

In children: early surgery ( 2-4 days) has been advocated

 trapdoor defect  cause ischemic damage and tissue fibrosis

Treatment and repair

Surgical: 7-10 days

 to allow swelling and hemorrhage to subside

Anesthesia: general,

neurolepsia

Approached:

subcilia

or

transconjunctival

 orbital rim

periosteum elevated off the orbital floor until the fracture site is identified entrapped tissue is freed carefully and elevated from the defect insert material for floor reconstruction

Cicendo 102, Cares for Vision

Cicendo 102, Cares for Vision

Cicendo

102, Cares for Vision

Postoperative Care

Ice packs +/- 48 hours

Broad spectrum antibiotics: 5-7 days

Patients are advised not to blow their nose

Complications

The result of injury itself or the surgical repair

Optic nerve injury

Retrobulbar hemorrhage

 immediate surgical exploration and drainage is necessary

Implant migration and extrusion

Another technique:

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Thank you